Healthcare Provider Details

I. General information

NPI: 1821090838
Provider Name (Legal Business Name): JACQUELINE M BRILL D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD SUITE 200
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

4302 ALTON RD SUITE 200
MIAMI BEACH FL
33140-2891
US

V. Phone/Fax

Practice location:
  • Phone: 305-893-9366
  • Fax: 305-893-4408
Mailing address:
  • Phone: 305-893-9366
  • Fax: 305-893-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: